A Case of Rhabdomyolysis and Weaning Failure in a Patient With Severe SARS CoV-2 Infection.

Abstract

Rhabdomyolysis is an uncommon complication in patients with severe SARS CoV-2 infection. This report presents a case of rhabdomyolysis in a critically ill patient with acute respiratory distress syndrome owing to COVID-19. The clinical manifestations included fever, tea-colored urine because of myoglobinuria, and elevated serum creatine kinase (CK). Muscle weakness was present and hindered successful weaning from mechanical ventilation. Prompt and aggressive fluid resuscitation was initiated in combination with alkalization of urine and furosemide administration. Treatment was titrated to maintain an adequate urine output with excellent clinical response. Severe COVID-19 infection may be accompanied by the late occurrence of rhabdomyolysis. CK levels should be monitored regularly and patients should be treated promptly with the adequate expansion of the extracellular volume. In our case, the intensive treatment proved to be effective in preventing acute kidney injury and related metabolic complications.